Background: Ischemic brain strokes consist two Third of all strokes and their complications bear a lot of cost and disability for the patient and society. In this study we seek for the effect of Erythropoietin on ischemic brain strokes’ outcome according to NIHSS (National Institudes of Health Stroke Scale) changes.Material and methods: This study is a RCT. All patients with focal neurologic deficit with primary suspicion of brain stroke underwent neuroimaging evaluations. after confirmation of new ischemic brain stroke, the patients with inclusion criteria randomized into two groups of cases and controls. NIHSS was defined for each patient and all patients received a routine treatment protocol. Erythropoietin 16000 IU as a bolus intravenous dose was given to case patients as soon as neuroimaging study confirmed new ischemic stroke and continued as 8000 IU each 12hr up to total dose of 56000 IU during 3 days. Patients were re-evaluated at days 14 and 28 and NIHSS was assessed by another neurologist blinded to patient’s group. Finally NIHSS changes of both groups were compared with each other.Results: Evaluations revealed that in days 14 and 28 during follow up, Erythropoietin was effective in NIHSS (P-value: 0.0001). This effect is of value in LOC Commands (P: 0.024), facial palsy (P: 0.003), motor arm (P: 0.0001), motor leg (P: 0.0001), sensory (P: 0.009) and best language (P: 0.023).Conclusion: Administration of High dose erythropoietin in first 24 hours can be effective on the reduction of ischemic stroke complication. However, a larger scale clinical trial is warranted.

Background & Aims Dysphagia is defined as swallowing dysfunction which leads to difficulty of passing food or water from mouth to hypopharynx or esophagus. Neurogenic dysphagia can be seen in lesions in one or both cerebral hemisphere or involvement of motor nucleus of swallowing muscles in brain stem or their motor axons (3, 4). As mentioned in literature, swallowing dysfunction is one of the most common complications in acute stroke occurring in 13-94% of cases which can directly affect patients’,short term and long-term prognosis (2). It might complicate the course of acute stroke by developing malnutrition, dehydration, dependency on others, and silent aspiration pneumonia which all can lead to prolongation of hospital stay (5, 6, 7). On the other hand, dysphagia is considered as an independent predictor of mortality in acute stroke patients (2, 8). Additionally, as discussed in many studies, location of brain infarction can predict the occurrence of dysphagia in stroke patients. For instance, infarctions in peri-insular cortex, right opercular cortex, left basal ganglia or thalamus are the most common sites leading to dysphagia following acute stroke. There are other factors associated with the occurrence of dysphagia in acute stroke including size of the infarction, right or left side of the lesion, age and gender of the patient and pre-existing comorbidities such as hypertension or diabetes (20, 22). Furthermore, it is suggested to initiate oral feeding as soon as possible in stroke patients. Therefore, it seems that early identification of dysphagia in acute stroke patient would lead to appropriate swallowing treatments and decrease the risk of pneumonia and related complications following acute stroke (9, 10). So, in this study we aimed to estimate the prevalence of dysphagia after acute ischemic stroke in patients referring to Rasool-Akram hospital, Tehran, Iran and revealing whether there is a correlation between incidence of dysphagia and stroke characteristics including vascular territory and right or left side of the stroke, demographic variables or pre-existing underlying diseases. Methods In this historical cohort study, 177 patients with acute ischemic stroke who were admitted to Rasool-Akram hospital were evaluated. The study was performed for a-six-month period. Patients with incomplete medical records or who were suffering from dysphagia prior to their admission were excluded. Ultimately, 137 patients were included in our study and their medical records were carefully studied and data such as presence or absence of dysphagia following stroke within 48 hours of admission, demographic data including age and sex, history of previous stroke, smoking, diabetes, hypertension, side of the brain infarction (right or left) and vascular territory of acute stroke were all evaluated. Data were analyzed using SPSS version 22 and analytical significance was considered as p-value<0. 05. Results From 137 patients, 60. 6% were male and 39. 4% female with median age of 65. 41±,13. 51 years old, (the oldest patients was 95 years old and the youngest, 31 years old). Diabetes and hypertension were in 35. 8% and 66. 4% of patients, respectively. 34 patients (24. 8%) were smoker and 40 patients (29. 2%) had history of previous stroke. Dysphagia was seen in 43 patients so, the prevalence of dysphagia following acute ischemic stroke was estimated 31. 4%. The localization of the infarction was divided into ten groups including complete middle cerebral artery (MCA), anterior cerebral artery (ACA), posterior cerebral artery (PCA), striatocapsular infarction, peri-insular infarction, and centromsemiovale infarction, infarction in territory of internal carotid ICA, cerebellum, brain stem and diffuse small vessel diseases. Statistically significant, dysphagia was more common in middle cerebral artery infarctions (p-value= 0. 017, OR= 2. 75 CI (2. 05-3. 55)). Regarding the side of the infarction, 43. 8% of patients had cerebral infarction on the left side, 36. 5% on the right, 2. 2% bilaterally and 17. 5% of patients had diffuse small vessel diseases. Interestingly, there was a significant correlation between the left side infarctions and dysphagia (p-value= 0. 034). Also, there was a significant correlation between age and occurrence of dysphagia, so that the older age was associated with the higher risk of dysphagia. No significant correlation was revealed between dysphagia and other variables including patient’, s gender, diabetes, hypertension, smoking and previous stroke in this study. Conclusion In this study, 31. 4% of patients had dysphagia after acute ischemic stroke which was nearly similar to other studies (12, 13, 14). However, in a meta-analysis study published in 2021, the prevalence of dysphagia following intracerebral hemorrhage (ICH) has been estimated up to 63. 6% (23) and up to 55% in stroke patients (24). Association between dysphagia and different vascular territory infarction or lesions pattern had been evaluated in many studies with inconclusive results and approximately all vascular territories had been associated with dysphagia in various studies including anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), and vertebrobasilar arteries (16, 21, 22). However, in some studies no statistical significance was explored and it was revealed that probably this is the size of stroke that has an association with dysphagia rather than vascular territory of infarction (14). In this study, there was a statistically significant correlation between dysphagia and MCA territory infarctions. The side of the brain lesion is another item that has been discussed in studies and it is proposed that dysphagia is more common in left side strokes, the same result revealed in our study. Though there was no association between patients’,gender, smoking or underlying diseases such as hypertension, diabetes, and dysphagia in this study, in one study, diabetes, female gender and older age was associated with higher risk of dysphagia (20). Nevertheless, more studies are required to evaluate association of these factors and risk of dysphagia more precisely. Currently, 2018 best stroke practice guidelines for the early management of patients with acute ischemic stroke from the American Heart Association/American Stroke Association, support early detection for screening dysphagia and recommend adherence to dysphagia screening in acute stroke centers by healthcare professionals, however practice remains diverse. A recent systematic review assessed the benefits of early detection for dysphagia with bed sides screening by a non-swallowing expert in adult stroke. This survey revealed that evidence from both experimental and observational studies showed a considerable protective benefit of dysphagia screening following adult acute stroke which decreases post stroke complications including pneumonia, dependency on others foe feeding, and length of hospital stay, and mortality compared with similar patients with no or relatively less precise early detection (24). Since it is highly recommended to start oral feeding as soon as possible in stroke patients, it is worth to screen every stroke patient for dysphagia several times during first days of stroke to evaluate patient’, s swallowing function and initiate appropriate feeding method accordingly. It seems that despite excellent strategies that have been developed during recent decades in acute stroke management or secondary prevention, dysphagia has been overlooked in practice and it appears that there are still some uncertainties regarding dysphagia screening benefit in patients with stroke and adequate comprehensive data is still lacking, especially in Iran. However, as explored in this study, dysphagia was a common consequence of stroke so that about one third of Iranian patients with acute ischemic stroke suffer from dysphagia which can result in unwanted complications or even death. This survey and similar ones, highlight the importance of early evaluation of dysphagia in acute stroke which can be easily performed by primary health care professionals in stroke institutions.

Introduction: Ischemic stroke is the most common cause of stroke, paralysis and movement disorders are the most symptoms of stroke. Therefore, it is important to find amethod for improving the disorders. This study aimed to examine the clinical efficacy of frankincense in patients with the acuteisc hemic stroke.Materials & methods: In this clinical trial, 06 patients with ischemic stroke were randomly allocated into the treatment and control groups (n=30). In the treatment group, in addition to routine treatment of stroke, four capsules containing 500 mg powdered frankincense were given each day, but in the control group, were performed only the treatment of stroke (nofrankincense) was performed. Thetreat ment lasted for 1 month. The NIHSS scale (for assessment of speech and muscle strength) at the beginning, the seventh dayand the end of the study for each patient was completed. Statistical analysis was performed using independent t-test, chisquare, and Mann withney in SPSS software.Findings: Results showed that only improvement of muscle strength in patient sleft limb increased significantly in stage IIin the treatment group than the control group.Discussion & conclusions: Addingfrankincense to treatment of patients with stroke can be effective on improvementmuscle strength in patients with muscle weakness and non-dominant side in acuteneurological disorders while that is not effective on improving muscle strength ofthe right limb or speech.

Background: Cerebrolysin, a preparation of low molecular weight neuropeptide and free amino acids, has been shown to have a great affect against excitotoxicity, inhibiting free radical formation, microglia activation and additionally neurotrophic action, promoting neuronal sprouting, and improving cellular survival and stimulating neurogenesis following stroke. The aim of this study was to determine the efficacy of Cerebrolysinon acute ischemic stroke.Materials and Methods: The present study was a randomised double blind clinical trial. The sample was 89 patients with confirmed the diagnosis of acute ischemic stroke. The patients divided in the intervention or control group with simple randomization. Patients in intervention group received 50ml cerebrolysin diluted in 100ml normal saline solution (totally 150 ml) infused over a time period of 30 minutes for 7 days and for control group patients, administered just 150ml normal saline infusion. Patients were assessed on days 1, 30 and 90 by Orgogozo, barthel index, MRS and NIHSS score.Results: The findings indicated that the mean of scores at the end of the first month was increased in comparision with the first day, 1.68 in intervention and -10.95 in intervention and case groups respectively and these differences were meaningful statistically (p<0.05). The comparison of scores at the end of three month treatment to the first day reported meaningful too (p<0.05). The findings demonstrated that at the end of the third month as compared with the first day, added 1.68 to case group score and reduced -13.21 from the control group score.Conclusion: Cerebrolysin is efficient in acute ischemic stroke patients and decreases the tissue damage severity in these patients. On the other hand, presumably it can reduces disabillity of the disease.

Background and Objective: The silent brain infarctions are common in first-ever stroke. Some recent studies show the possible role of silent brain infarction in ischemic stroke. The aim of this study was to evaluate the frequency of silent brain infarction in acute first-ever ischemic stroke and its association with stroke risk factors.Materials and Methods: This descriptive - analytical study was carried out on 203 (94 males, 109 females) patients with acute first-ever ischemic stroke in Shafa hospital in Kerman, Iran during 2010. The diagnosis of ischemic stroke was made by physical examination and was confirmed by MRI and CT Scan. A questionnaire containing demographic information and risk factors including hypertension, diabetes, hyperlipidemia, cigarette smoking, ischemic and non-ischemic heart disease for stroke as well as presence of silent stroke was completed for each patient. Data were analyzed using SPSS-16 and logistic regression test.Results: The mean age of patients was 62.56 ±17.35 years. Among our patients history of hypertension, hyperlipidemia, cigarette smoking, diabetes, history of ischemic heart disease, history of other cardiac disease and silent stroke were observed in 66(32.5%), 26(12.8%), 16(7.9%), 40(19.7%), 27(13.3%), 16(7.9%) and 31(15.3%), respectively. The probability of silent stroke among patient with hyperlipidemia, was 3.7 times more than those without hyperlipidemia (95%CI: 1.556-12.780, P<0.05). There was no significant correlation between silent stroke and the above risk factors.Conclusion: Silent stroke was found in 15% of patients with ischemic stroke. Control of hyperlipidemia can have a vital role in the prevention of silent stroke.

Introduction: stroke is the most important brain disease. Stroke leads to a reduction in bone density, altered calcium homeostasis, and an increase in hip fractures. Some recent studies show effects of vitamin D on stroke and vice versa. The purpose of this study was to determine of serum vitamin D levels in patients with acute stroke.Methods: In this cross-sectional study, we compared the serum 25-dihydroxyvitamin D levels of 44 patients with first-ever ischemic stroke with results obtained by measuring 44 healthy ambulant elderly subjects. Data were analyzed using T-test and ANOVA.Results: patients in two groups were male and the rest were female. The average age of all patients in both groups were 66.65±13.4. The mean of serum vitamin D in acute stroke was.18.1±6.33 and in control group was 19.54±5.28. There was no significant difference between the two groups on serum level of vitamin D. There was no significant difference between serum vitamin D with age and sex.Conclusion: There was no difference in serum vitamin D in patients with acute stroke and controls.

Background: Several studies have assessed the association between Chlamydia pneumoniae infection and thrombotic ischemic strokes. This study was designed to investigate the association between this organism and ischemic strokes in Iranian patients.Methods: Antibodies to Chlamydia pneumoniae (CP IgA and IgG) were measured in 81 patients with stroke and 43 controls. CP IgG and CP IgA titers more than 1.1 Immune Status Response (ISR) was considered as positive.Findings: We found that 9.3% of controls and 13.6% of cases were CP IgA seropositive. Although the difference between these two groups was prominent but it was not statistically significant (p=0.25). The mean CP IgA titer was significantly higher in the case than in the control group (0.6 ± 0.3 vs. 0.47 ± 0.3 ISR, respectively, p=0.03). This difference was not significant for CP IgG titer. Conclusion: The higher titer of CP IgA in patients with ischemic stroke than in controls might suggest the co-existence of this infection with ischemic stroke. Assessment of this association needs longitudinal studies.

Introduction: In addition to the limitations imposed on the patient, ischemic stroke has high economic and social costs. Despite many efforts to treat these injuries, there is still no complete recovery and complete improvement in patients with ischemic stroke. Ischemic stroke is followed by a series of events, such as inflammation, increased oxidative stress, and the spread of damage, that can lead to mitochondrial damage, protein degradation, and cellular apoptosis. Any approach that can protect nerve cells from ischemic injuries can improve the healing process. One of these methods is the use of intracellular factors in the treatment of stroke, which can control various cellular pathways, such as apoptosis, division, and other pathways. Conclusion: In this article, the role of some factors involved in improving the process of ischemic stroke and the treatment strategies with these factors are discussed.

Background and Objective: Several studies have shown that during stroke changes occur in some paraclinic parameters which may have either prognostic or diagnostic value, including electrocardiographic changes. This study was done to evaluate the prognostic value of prolonged QT segment in patients with ischemic stroke.Materials and Methods: This descriptive study with an easy convenient sampling was carried out on 175 patients (73 male and 102 female) with acute ischemic stroke whome have been diagnosed by brain imaging (computed tomography scan and magnetic resonance imaging). All patients were suffering from stroke for the first time and if they use any drug or have underlying disease except diabetes mellitus- hypertension- heart disease and hyperlipidemia were excluded. In the first 24 hours of admission, an electrocardiogram (ECG) were taken for measurement of QT segment and according to death or discharge, patients were divided into two groups, and the mean of QT segment (corrected QT) subsequently were assessed. Data were analyzed using SPSS-15, Chi-Square and independent t-tests.Results: Twenty patients died in the course of admission. The mean of QT segment (corrected QT) in dead patients was 471.15±61.70 and in discharged patients was 421.52±62.96 (P<0.05). The abundance of prolonged QT segment accompanied with death was more frequent. Hypertension, diabetes mellitus, hyperlipidemia and heart disease were significantly correlated with morbidity and mortality (P<0.05). There is no relation between mortality with age and sex.Conclusion: This study showed that mean of QT segment (corrected) and also cases of prolonged QT segment were abundant among dead patients, therefore prolongation of QT segment has prognostic value in patients with ischemic stroke.